Promoting health through a continuum of health and wellness interventions around type 2 diabetes

Background: First appearing in Quebec in 2010, an initial population-based responsibility initiative emerged in France in 2007 through the Open Arena for Public Health (EPSP) in the Nice region. It brings together all public health stakeholders in the region to resolve complex issues surrounding population health. To complement their model in this region, the partners added to the EPSP initiative an experiment led by the Fédération Hospitalière de France (FHF) on population-based responsibility using a pathology-based approach.

 

Approach: This study is based on feedback concerning the integration of two approaches to population responsibility in France, in the Nice area : the Open Arena for Public Health and the methodology of the French Hospital Federation. The combination of these two approaches brings together cross-sector partners around collaborative multi-level governance. Feedback is provided by stakeholders involved in the implementation of these approaches.

 

Results: Since 2007, the EPSP has enabled the emergence of various health promotion programs in the region, based on a Canadian population-based approach. For example, the AmStramGram' program, which aims to prevent overweight and obesity and promote health among young children in Nice, has been implemented since 2023 in two priority neighborhoods of the city, thanks to an intersectoral initiative. It now runs a total of around 15 initiatives between the two neighborhoods, such as improving urban environment (cycle path, walking path), food availability, program targeting the first 1000 days.

 

To continue the continuum of health and well-being in relation to this major public health issue, since 2025 the EPSP partners have added the FHF's clinical methodology based on population responsibility applied to type 2 diabetes. This strengthens the links between the city and the hospital to promote an integrated approach to care throughout life.

 

Implications: The implementation of these two approaches, one combining intersectorality and complexity, and the other based on pathology, makes it possible to propose a model that integrates health promotion, prevention, curative care, rehabilitation, and palliative care, with a specific focus on identifying health determinants. It highlights the importance of an “integrator” to liaise between the various stakeholders in a given area.